Xue Junshuai, Jiang Jianjun, Liu Yang
Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China.
J Inflamm Res. 2022 Mar 15;15:1899-1906. doi: 10.2147/JIR.S357758. eCollection 2022.
Idiopathic hypereosinophilic syndrome (IHES) often causes inflammatory damage to multiple organs. However, whether immune/inflammatory indicators and other factors are associated with mortality in patients with IHES remains unclear.
The clinical data and follow-up results of 167 patients with IHES were retrospectively analyzed using Cox regression analysis and receiver operating characteristic curve (ROC).
Of 167 patients, 120 were men (71.9%) and 47 were women (28.1%). The median age was 52 (36.0, 68.0) years. The median follow-up period was 42.8 (18.5, 75.1) months, during which all-cause mortality occurred in 26 patients (15.6%). Age (HR: 1.041, 95% CI: 1.015-1.068; p = 0.002), lymphocyte counts (10/L, HR: 0.866, 95% CI: 0.816-0.907; p = 0.013), platelet counts (10/L, HR: 0.994, 95% CI: 0.989-0.999; p = 0.012) and NLR (HR: 1.161, 95% CI: 1.054-1.280; p = 0.003) were independent risk factors for all-cause mortality. There was no relationship between PLR, and SII and all-cause mortality (p = 0.181 and 0.202, respectively). ROC analysis showed that the AUCs of age, lymphocyte count (10/L), platelet count (10/L) and NLR were 0.712 (95% CI: 0.601-0.824), 0.584 (95% CI: 0.448-0.719), 0.686 (95% CI: 0.560-0.812), and 0.797 (95% CI: 0.695-0.899), respectively, with sensitivities of 0.5, 0.462, 0.769, and 0.792, respectively, and specificities of 0.765, 0.745, 0.617, and 0.845, respectively. Kaplan-Meier analysis (Log rank test) showed that patients with age ≥73.5 years, lymphocyte count (10/L) <1.45, platelet count (10/L) <225 and NLR ≥2.54 had high mortality. Patients with high NLR (≥2.54) usually have multiorgan involvement, with cardiac involvement and skin involvement being the most common. Patients with NLR ≥2.54 had significantly higher absolute eosinophil counts (p = 0.047) and percentages (p = 0.041).
We identified NLR for the first time as an independent predictive factor for all-cause mortality in patients with IHES, necessitating its further application in clinical practice.
特发性高嗜酸性粒细胞综合征（IHES）常导致多器官炎症性损伤。然而，免疫/炎症指标及其他因素是否与IHES患者的死亡率相关仍不清楚。
采用Cox回归分析和受试者工作特征曲线（ROC）对167例IHES患者的临床资料及随访结果进行回顾性分析。
167例患者中，男性120例（71.9%），女性47例（28.1%）。中位年龄为52（36.0，68.0）岁。中位随访时间为42.8（18.5，75.1）个月，期间26例患者（15.6%）发生全因死亡。年龄（HR：1.041，95%CI：1.015 - 1.068；p = 0.002）、淋巴细胞计数（10⁹/L，HR：0.866，95%CI：0.816 - 0.907；p = 0.013）、血小板计数（10⁹/L，HR：0.994，95%CI：0.989 - 0.999；p = 0.012）和中性粒细胞与淋巴细胞比值（NLR，HR：1.161，95%CI：1.054 - 1.280；p = 0.003）是全因死亡的独立危险因素。血小板与淋巴细胞比值（PLR）和全身炎症反应指数（SII）与全因死亡无相关性（p分别为0.181和0.202）。ROC分析显示，年龄、淋巴细胞计数（10⁹/L）、血小板计数（10⁹/L）和NLR的曲线下面积（AUC）分别为0.712（95%CI：0.601 - 0.824）、0.584（95%CI：0.448 - 0.719）、0.686（95%CI：0.560 - 0.812）和0.797（95%CI：0.695 - 0.899），敏感性分别为0.5、0.462、0.769和0.792，特异性分别为0.765、0.745、0.617和0.845。Kaplan - Meier分析（对数秩检验）显示，年龄≥73.5岁、淋巴细胞计数（10⁹/L）<1.45、血小板计数（10⁹/L）<225且NLR≥2.54的患者死亡率较高。NLR高（≥2.54）的患者通常有多器官受累，以心脏和皮肤受累最为常见。NLR≥2.54的患者绝对嗜酸性粒细胞计数（p = 0.047）和百分比（p = 0.041）显著更高。
我们首次确定NLR是IHES患者全因死亡的独立预测因素，有必要在临床实践中进一步应用。
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